Assessment of antineutrophil extracellular traps antibodies (ANETA) in the serum of systemic lupus erythematosus patients and its relation to disease activity and damage

Background Neutrophil extracellular trap formation (NETosis) is a distinct mechanism of neutrophil cell death and has been increasingly implicated in the pathogenesis of systemic lupus erythematosus (SLE) and other autoimmune disorders. Objective This study was designed to evaluate serum level of antineutrophil extracellular traps antibodies (ANETA) in patients with SLE and its relation to the activity and damage of the disease. Patients and methods This case-control study enrolled 30 female patients with SLE (15 de novo and 15 on treatment), alongside 30 age- and sex-matched healthy controls (Control group). A blood sample (4 mm) was withdrawn for assessment of Neutrophil extracellular traps (NETs) complexes and ANETA levels by ELISA. Results NET levels were significantly elevated among SLE de novo group upon comparing with both SLE treatment and control groups ( P= 0.007 and 0.003, respectively). As for the ANETA levels, despite being higher among SLE de novo group, yet these differences did not reach statistical significance on comparison with SLE treatment and control groups ( P >0.05). ANETA results correlated positively with NETs reading ( P <0.001). Among SLE treatment group NETs and ANETA were positively correlated with SLE disease activity index and Systemic Lupus International Collaborating Clinics Damage Index. Conclusion The positive correlations of NETs and ANETA with SLE disease activity index and systemic lupus international collaborating clinics damage index highlight the possibility of considering NETs/ANETA as potential diagnostic and prognostic indicators in SLE, reflecting both disease activity and organ damage. However, larger longitudinal studies are needed to validate NETs/ANETA as reliable biomarkers in SLE.